Gliederung

In neurosurgery, the number of surgeons having experience with the waterjet device for tissue dissection is increasing. However, a detailed account of its advantages and disadvantages in glioma surgery is still missing. Theoretically, it could allow a reduction of blood loss and surgical trauma as well as enable an increased accuracy of tumour resection in well-vascularized or poorly demarcated gliomas.

To evaluate its application characteristics, 67 glioma patients (19 pts. WHO grade I+II, 48 pts. WHO grade III+IV; 43 male, 24 female; mean age 53 yrs, range 12 - 81 yrs) were operated on with the waterjet between June 1996 and December 2004. In 12 cases, the instrument was directly compared with ultrasonic aspiration. Intraoperatively, the general aspects of handling of the device, the extent of its application, and the quality and helpfulness for dissection and tumour aspiration as well as vessel preservation were monitored.

In all cases, the waterjet enabled precise dissection of the tumour from the brain without complications. The mean operation time was 158 min (range 105 - 232 min), the mean intradural blood loss 69 cc (range 10 - 450 cc). Vessels were preserved, and - in 56 of 58 cases intended - radical tumour resection was achieved based on postoperative MRI studies. Tumour aspiration was possible in all but one case. However, tumour debulking was performed more efficiently with ultrasonic aspiration.

The waterjet can safely be applied in gliomas of all grades. The device is particularly suitable for precise glioma parenchyma dissection and might alleviate complete tumour resection and a reduction of blood loss. For tumour aspiration, the ultrasonic aspirator appears to be more efficient. Currently, a randomized study is on its way to evaluate the objective quality of the device compared with conventional surgical techniques.